Laserfiche WebLink
i <br /> LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUN'T'Y PU$LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE 3"P E'LOOR.YFOCK'ION,CA 95202(209)4611-3420 <br /> DABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> APN Zc Y- 4, �i C ~ PARCF.I.SIZE:_ <br /> /ef _CITY12IP. BOILDINC PERMITD <br /> OWNER NAM`'. - \� ADDRESS <br /> CITYrZIP -ter _ PHONE NUMBER <br /> CONTRACTOR I �J ADDKF:SS - 715 <br /> " <br /> f/ <br /> C I'I,Y:zlP �` / PHONE NBMf. n� L`CQ <br /> V <br /> GEOGRAPHICAL INFORMATION: COORDINAIIES:X. Y_ TOWNSHIP -RANGE SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE: NUMBER OF LI VIN UNITS; <br /> PNEW INSTALLATION l3ES IDENCF. ,NUMBER OF BEDROOMS: <br /> ❑ <br /> ❑ REPAIWADDITION COMMERCIAL <br /> NUMBER OF EMPLOYEES: <br /> C3 DESTRUCTION ❑ OTHER 'J <br /> ❑ ENGINEERED.ALTERNATIVE <br /> CHAR,ICTER OF SOIL TO DEPTH OF 3': PITISUMP SOIL CHARACTER: WATER TABLE DEPTH: <br /> ❑ PERC'FES-F(S) HOWMANY APPLICATIONS-_. -- -__-. -- —_-_-- <br /> ❑ SEPFICTANK TYPL;fMI.G-rVCAPACITY "toa i�OFCOMPARTMENTS <br /> ❑ GRFASETRAP TYPE;MFG_. CAPACITY 4 OF COMPARTML•NTS <br /> t%) <br /> O PKGTx PLANT DISTANC'F.TO NEAREST: wEu._ FOUNDATION PROPERTY LINE <br /> ❑ LIFTSTATION SIZE TYPE Of P1:MP� SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE #OF LINES: LENGTH OF LIN LIS- mrrAnCRTONFARFSr. WELL FOUNDAIlON PROPERTY LINE <br /> 1NFLITRATOR CHAMHERS. <br /> •////yyydn .� f/a <br /> ❑ FILTER BED WIDTH-L LEUUTH/Z�c DEPTHLZ01.WAWRF NEARE?P: WELL FOUNDATION PROPERTY LINE S <br /> ❑ MOUNDED WIDTI[ LF.NG'PH DEPTH__ DISTAN(YTONTAR4sr: WELL FOUNDATION PROPERTY LINE <br /> ❑ SUMPS WIDTH LENGTH DEPTH ouTM'cYrV NEAREST; WELL FOUNDATION PROPERTYIJNE <br /> ❑ DISPOSAL PONDS WIDTH LENGTfI DEPTIL DISTANCT.TONEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS k DIAMETER`___ DEPTH U157ANCETO-E .RT: WELL FOUNDATION PROPERTY LINE <br /> \. <br /> 1 HEREBY CERTIFY THAT I HAVE PAEPAHED'fI11S APPLICATION ANO THE WORK WILL 130:DONE IN ACCORllANCti WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AND REGULA'T'IONS OF SAN JOAQUIN COUNTY. - <br /> MINIMUI 41 VOADVA E NOTICE REQUIRED FOR INSPECTIONS-pLEA$E CALL(209)4E8-3473 <br /> SIGNED: TITLE;��?±JRi <br /> i 1 <br /> - i .-I----L......... <br /> I <br /> 1 ' <br /> 1 r <br /> } I <br /> I i 1 ! --I - ---- <br /> .G �{ JI r <br /> _ - - <br /> ._+ - <br /> y _ 1 <br /> } <br /> } <br /> _ r <br /> Dl�l R 'iEh'I�J.�i.ICti;_ , <br /> JFAIHF�I HL IiCIl1 <br /> �. �.. T-•-j---I I r i - <br /> I ' <br /> I <br /> -----y_.. . I <br /> � All <br /> DEPARTMENT USE ONLY rY, �/7' <br /> APPLICATION ACCEPTEDDY. ALN DATE: I\i. � }� AREA <br /> ��`•/ EMPLOYEE 1. _DISTRIC'T_-+.� LOCATION_}= <br /> INSYFSI'ED RY:— DATE.///� OL PERMIT FINAL4 YES DATE: INSPECTOR: <br /> COMMENT S: <br /> PE CODE 5C INTO AMOLNT 4536WASH RECEIVED DATE EnmmsmR ICEREOUEST. INVOICE* SEPTIC ID.+ <br /> REMITTED RY <br /> zli� ZEA <br /> ye, g 3! <br /> RFYISED IHS-01 -- "— <br />